WEAVER'S BOTTOMORPIRIFORMIS SYNDROME

Earlier this week I saw a patient for PIRIFORMIS SYNDROME that had come quite a distance to see me. This person had some absolutely brutal FASCIAL ADHESIONS and Scar Tissue around the area of the buttocks / posterior hip. I had treated this person once before --- several months ago; but in the meantime, they had been to an older "Country Doctor" (there are not many of these left) who told this individual that their problem was not Piriformis Syndrome, but was instead something called Weaver's Bottom. Weaver's Bottom?

Although I do not claim to be a very intelligent person, this term, "Weaver's Bottom" was completely new to me --- something I had never heard of before. My patient said that it is what people who used to sit on a hard stool or chair all day long, while weaving on a loom or wheel, used to get. Of course I wanted to know more, so I jumped online and started to read.

Weaver's Bottom is the 'Olde Tyme' common name for something called Ischial Bursitis. Let me help you find your Ischial Tuberosity. First (and this is extremely important), look around and make sure no one is watching you do this (you'll understand why momentarily). Now lean to one side and run your finger along the bottom part of your bottom --- right where you sit. Now feel for what I tell my patients is the "Butt Bone". You just found your Ischial Tuberosity!

In the picture below, the Ischial Tuberosity is bony prominence that is just below the "eyes" of the pelvis ---- the lowest part of the pelvis that you sit on. Now, take a look at how far the Piriformis Muscle is from the Ischial Tuberosity. Although the Sciatica (leg pain) could certainly radiate into the area of the Ischial Tuberosity, I do not typically see Piriformis problems referring pain solely to that particular spot.

Photo by Beth O'Hara

WEAVERS BOTTOM -vs- PIRIFORMIS SYNDROME

There is a fluid-filled sac that sits on the bottom of the Ischial Tuberosity called the Ischial Bursa. The purpose of any bursae is to protect both tendons and bones from the friction that they create when they rub against each other during movement. The word 'itis' means INFLAMMATION; and when used in conjunction with the word, "bursa", you get BURSITIS --- an inflammation of the bursa. Although I think that there are lots of people who suffer with Ischial Bursitis (Weaver's Bottom), my guess is that it is frequently misdiagnosed.

I have always said that much, if not most of what is diagnosed as bursitis, is really Tendinosis. TENDINOSISis the problem that doctors used to refer to as tendinitis. As far as the medical profession is concerned, it makes no difference to them what they call it because they treat it the same way ---- anti-inflammatory drugs and CORTICOSTEROID INJECTIONS. In some cases of severe Ischial Bursitis, the bursa is actually removed surgically.

There is a direct relationship between the Piriformis Muscle and the Sciatic Nerve --- the nerve that causes leg pain when irritated. Look at the picture on the left. If you move down from the Piriformis, you will see the white tendon of the long head of the Hamstring Muscle anchoring itself to a bony prominence (red). This bony prominence is the Ischial Tuberosity or "Butt Bone" as I called it earlier.

Just from looking at the anatomy of the area, you should start to realize that Weaver's Bottom (Ischial Bursitis) and Piriformis Syndrome (with sciatica or without) are two very different problems that in most cases should be fairly easy to distinguish from one another. For one thing, you will not get sciatica with Ischial Bursitis. For another thing, HAMSTRING TENDINOSIS will usually be helped by our Scar Tissue Remodeling work, but it may very well aggravate a true bursitis.

Sitting tends to aggravate both Piriformis Syndrome and Ischial Bursitis; and Ischial Bursitis is usually caused by either traumatic or repetitive injury --- the same things that can cause Piriformis Tendinosis. This can sometimes make Weaver's Bottom somewhat difficult to distinguish from Hasmstring Tendinosis. This is a very similar phenomenon to BICEPS TENDINOSIS being frequently misdiagnosed as Subacromial Bursitis. Just be aware that MRI will usually fail to identify any of these problems (HERE), and is not typically a good diagnostic tool for them.

If this information helped you, play it forward by liking us on FACEBOOK.

Good article. Very informative and helped confirm my Doctor diagnosis of Weaver's Bottom.

Reply

Anne

5/5/2013 01:09:03

Excellent description of the various symptoms...how to determine what's going on. All I can say is that it hurts a lot and I don't know where to turn.

Reply

Marilyn

10/11/2013 19:38:52

Anne, I'm with you. If you find any help, please let me know.

Reply

philip

10/9/2013 13:30:10

Thanks for the insights. Which kinds of doctors can diagnose and treat the above? Very few, as you confirmed seem to have the slightest awareness or concern of this chronic condition that truly degrades tnhequality of life for many.

Reply

Dr. Russ

10/10/2013 10:45:03

This is a difficult diagnosis because it is so often thought to be either Piriformis Syndrome or Disc-related. All it takes to diagnose anything is some know how and experience. The internet is a great tool to this end because it is helping people figure things out that their doctor(s) have failed them on. Many doctors deride internet medical advice / information for that very reason.

Reply

Marilyn

10/10/2013 21:19:35

But what can be done. I have had this for three years, very painful. Cannot enjoy car rides, or sitting around a table with friends. Has anyone found relief?

Rusty McCraw

12/3/2013 22:24:16

My wife has Ischial Bursitis , and we are desperately trying to find the right kind of help. We need some advice on where to go. Please advise, Thanks Rusty Mc

Reply

Dr. Russ

12/5/2013 10:00:01

Email me at RussellSchierling At Yahoo Dot Com.

Reply

Karen Martignoli

1/11/2014 12:32:04

I have pain in my left groin. I've had two arthroscopic surgeries with no relief. Scraped some arthritis but nothing serious - any suggestions?

Reply

Dr. Russ

1/13/2014 07:14:31

Does not really sound like either of these problems.

Dr. Russ

Reply

Heather

1/20/2014 21:38:23

I was a rider (horses) until 25 and experienced great sitz and lower back pain throughout. I also was a sprinter, softball catcher, and hurdler, all of which really tightened my hams up and lower back. Although, I was told I had great wide pelvis for birthing, I couldn't get beyond 4-7 cm. Now I'm 46 and for nearly 20 years I've had increasing debilitating sitz, ham, hip, and lower back pain in my work as an architect with 5-12 hour road trips almost weekly. Riding horses or trying spin classes now is excruciating and simply getting up from a seated position after even a half hour bends me over in pain. I injure very easily in that region, last tearing at the ischial tuberous and pulling medials and piriformis, plus pinching off the sciatic. Nobody gave me any help in understanding this chronic situation. I'm very athletic but I can barely even jog anymore. I don't know what to do about it or if anything can be done. Help?

Reply

Dr. Russ

1/21/2014 09:58:49

Could very well be something I can help you with. Are you nearby?

Reply

Sherry

6/27/2014 21:45:41

I have had tolerable pain with prolonged sitting for almost 2 years. In Feb., my mother died, and I traveled 10 hrs, by car. Since then, the pain has been constant when I sit, or recline... standing causes no pain. I am a nurse, and am on my feet most of the day. I have had CT's, MRI's and there is nothing significant in my spine. My doc referred me for CT guided steroid injection. (The radiologist said he could see 'inflammation' b/l on the CT) I am at my wits end. What do I do???? Repeat the injection??? Do exercises??? HELP!!

Reply

Dr. Russ

6/29/2014 07:56:22

If you have not yet done any Tissue Remodeling, that should be next on your list.

Reply

Cindy Colson

7/22/2014 07:26:38

My mother has suffered with severe rectal pain. It hurts her 24/7. It is not tailbone pain, but actually in rectum. Is this possibly related to the
PIRIFORMIS SYNDROME? Any help or insight from you would be very much appreciated. This has been going on for almost 4 years. Thank you and hope your day is great! Cindy

Reply

Dr. Russ

8/5/2014 06:27:29

I have actually seen many patients that have scar tissue right up to their anus. As far as your mother is concerned, it's almost impossible to tell from a history.

Sincerely,
Dr. Russ

Reply

Gavin

1/8/2015 17:31:40

Hello please help with ur opinion. I am a college basketball player and into weights and training and want to compete in body building after bball. I never stretched my hips. I sat for the whole summer driving 6 hrs a day. I never stretched my hips. Just went and lifted without stretching for last 2 years.I sit a lot during day.I have piriformis syndrom I believe. Doctors don't know why I am having sciatic pain. I want to train and workout again but my right side quadratus lumborum trigger points r active and sciatic pain hurts to bad (heel, calf ). I had mri ct scan nothing proves I'd have scatica.the pain never radiates. I don't get it when bend or twist just when I sit! Please help thank you

Reply

Dr. Russ

1/13/2015 10:28:48

Could very well be a Myofascial (Scar Tissue) thing, but impossible to say without looking.

Sincerely,
Dr. Russ

Reply

Darren

6/1/2015 04:17:13

I've had this problem on and off for yrs. I do long distance running and even though it doesn't stop me running but it hurts to sit for any length of time. I had a cortisone injection 6 months ago and all has been going well but it's flaring up again so I'm off to get another cortisone injection tomorrow.
Is It possible to get an ishial bursa drained?

Reply

Dr. Russell Schierling

6/6/2015 04:21:53

Hello Darren,

Not that I am aware of.

Dr. Russ

Reply

Brian

6/11/2015 18:09:47

Super article doc. I have had pain in my right buttock or over one yr now. I believe that i finally got proper diagnosis of ischial brusitis. I now feel that i am getting the sameain on my left side. Have you seen this before? Or is it usually limited to one side? Thnx doc.

Reply

Dr. Russ

6/15/2015 08:47:48

Hello Brian,

While this could happen bilaterally, this would lead me to start thinking more in terms of a global inflammatory issue or a biomechanical aberration of your pelvis, feet, etc.

Hi Dr. Russ. I have a yoga studio, and a friend of mine has been coming to class regularly for some 3 years. The pain you describe here is something she's been having on and off for the last 5 years. She has been diagnosed finally with Ischial Bursitis. She has tried many treatments including cortisone injections into the Bursa, shock wave therapy and tissue manipulation. She can't get relief. She rides her bike instead of driving and continues with yoga. Is there any way I can help her with yoga therapy? What would you suggest?

Reply

Dr. Russ

7/29/2015 07:44:30

Hello Gillian, The very first thing I would do is to look up my information (my blog category) on "Inflammation". If she actually has an "itis" or inflammation of her bursa, she may very well be able to deal with it naturally. As the article says, many cases of bursitis --- wherever they are found --- are actually Tendninosis or a Fascial Adhesion, which would require a different approach as in some sort of intense bodywork to break it up.

Sincerely,
Dr. Russ

Reply

Your comment will be posted after it is approved.

Leave a Reply.

RUSS SCHIERLING

Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy, full-service chiropractic clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).